System and method for providing closed loop infusion formulation delivery

ABSTRACT

A system and method for providing closed loop infusion formulation delivery which accurately calculates a delivery amount based on a sensed biological state by adjusting an algorithm&#39;s programmable control parameters. The algorithm calculates a delivery amount having proportional, derivative, and basal rate components. The control parameters may be adjusted in real time to compensate for changes in a sensed biological state that may result from daily events. Safety limits on the delivery amount may be included in the algorithm. The algorithm may be executed by a computing element within a process controller for controlling closed loop infusion formulation delivery. The biological state is sensed by a sensing device which provides a signal to the controller. The controller calculates an infusion formulation delivery amount based on the signal and sends commands to an infusion formulation delivery device which delivers an amount of infusion formulation determined by the commands.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a divisional of and claims priority from U.S. patentapplication Ser. No. 10/033,173 filed Dec. 26, 2001, which in turnclaims the benefit of U.S. Provisional Patent Application No.60/335,664, filed Oct. 23, 2001, and relates to U.S. Provisional PatentApplication No. 60/318,062, filed Sep. 7, 2001 each of which are herebyincorporated by reference herein.

BACKGROUND OF THE INVENTION

1. Field of the Invention

The present invention relates generally, to infusion pump systems forthe delivery of infusion formulations, and in particular, to aclosed-loop algorithm for use in conjunction with a process controllerfor controlling the delivery of an infusion formulation to a body basedin part on sensed blood glucose levels within the body.

2. Description of Related Art

Infusion pumps have been used for the programmed delivery of measureddoses of an infusion formulation. (An infusion formulation is defined inthe present disclosure as the substance being delivered by the infusionpump. This substance may comprise either a mixture of differentcomponents or it may be a single, pure substance, including, but notlimited to drugs, dyes or other indicators, nutrient, or the like.) Atypical example of such use is the delivery of an insulin formulation toa patient.

In the case where the infusion formulation is an insulin formulation, asensing device may regulate the delivery of the insulin formulation bysensing the levels of blood glucose in the person. The delivery of theinsulin formulation may be controlled by a control device associatedwith the pump having as an input a sensed blood glucose level. Thecontrol device may control activation of the pump to deliver anappropriate amount of the insulin formulation in accordance with thesensed blood glucose level.

Insulin is a protein hormone normally formed within the human pancreas.Because it regulates carbohydrate (sugar) metabolism, insulin isrequired for normal metabolic function. More specifically, insulin helpsthe body metabolize glucose. To avoid medical problems such ashypoglycemia and hyperglycemia, blood glucose levels should bemaintained within a specific range. A normal range for glucose in thehuman body may be between 85 and 120 milligrams/deciliter (mg/dl).

In a non-diabetic person, insulin is secreted by the pancreas in smallamounts throughout the day (basal rate of insulin secretion). Inaddition, the amount of insulin secreted by the pancreas may be modifiedunder certain circumstances. For example, the pancreas of a non-diabeticperson normally secretes larger amounts of insulin (bolus rate ofinsulin secretion) when the person ingests a meal to preventpostprandial hyperglycemia, i.e., abnormally increased sugar content inthe blood.

In contrast to the non-diabetic person, a diabetic person's pancreas maynot secrete the required amount of insulin. Thus, the diabetic personhas to somehow artificially introduce the insulin into the body. Onemethod of introducing the insulin is by the conventional insulinformulation injection method using a syringe. Using this method, thebody's blood glucose level may be monitored (for example, by checking ablood sample) and the amount of insulin to be injected may be adjustedaccordingly. For example, after a meal the blood glucose level may bemonitored and an appropriate amount of insulin may be injected into thebloodstream of the user.

In the alternative, a diabetic person may choose to use an infusion pumpsuch as the infusion pump described above. By using an infusion pump, adiabetic person may be able to adjust insulin delivery rates for thepump in accordance with the user's needs. These needs may be determinedbased on prior experience and/or the results of glucose monitoring (forexample, by a sensing device in combination with a communicationdevice).

In addition, infusion pumps may be engineered to function as anartificial pancreas. Such an infusion pump may deliver a specific amountof insulin formulation at specific intervals. As discussed above, asensing device associated with the pump may monitor the blood glucoselevel of the user and the blood glucose level may then be used by thepump to automatically regulate the delivery of the insulin formulation.

It is known to use as a control device a process controller forperforming automatic regulation of the infusion pump. The processcontroller, for example a processor or other computing element, controlsthe process such that a process variable is maintained at a desired setpoint value (also referred to in the present disclosure as the “goal”).Such process controllers typically use a set of control parameters whichhave been determined through, for example, experimentation orcalculation, to operate in an optimal manner to control the processvariable. Although not the only possible technique, these controlparameters are typically dependent on the anticipated range ofdifferences (“error values”) that result between the process variableand the set point during actual operation of the process.

Ordinarily, infusion formulation delivery systems utilize controlsystems having an input-response relationship. A system input, such as asensed biological state, produces a physiological response related tothe input. Typically, the input (such as a sensed blood glucose level)is used to control some parameter associated with the response variable(such as an insulin infusion rate or an amount of insulin).

A process controller employed in the delivery of an insulin formulationtypically executes a closed-loop algorithm that accepts and processes ablood glucose level input supplied to the controller by a sensingdevice. The closed-loop algorithm may adjust insulin formulationdelivery as a function of, for example, the rate of change over time ofthe sensed glucose level.

These closed-loop algorithms have many limitations. Some of theselimitations result from the fact that a process controller employing aclosed-loop algorithm to control the delivery of an insulin formulationmay be restricted to only adding insulin formulation to the system. Onceinsulin formulation is added to the system, normally the controllercannot retrieve it.

Additional limitations result from the fact that certain parametersaffecting glucose production may not be adequately compensated for bythese closed-loop algorithms. For example, certain daily events maysignificantly affect glucose production levels in the human body. Thus,these events may also significantly affect the amount of insulinrequired to metabolize the glucose.

Exercise, for example, has been shown to lower blood glucose levels inthe human body. Thus, exercise may result in a dip in blood glucoselevels and a corresponding decrease in the amount of insulin formulationdelivered by the body. Longer or more strenuous exercise events mayresult in a greater dip in blood glucose level than shorter and lessstrenuous exercise events.

Similarly, sleep and stress may affect the body's ability to burncarbohydrates and therefore may affect glucose levels. For example,glucose metabolism has been found to be slower in a sleep deprivedstate. In addition, elevations of certain stress hormones within thebody may also result in slower glucose metabolism. Thus, longer orshorter periods of sleep or stress may result in more or lesssignificant changes in glucose levels.

Furthermore, the ingestion of certain medications may affect a user'ssensitivity to insulin, i.e. a given amount of insulin may be more orless sufficient depending on whether or not a particular medication hasbeen taken.

An additional event that may significantly affect the production ofglucose in the body is the ingestion of food. This results in part fromthe fact that during digestion carbohydrates are broken down intoglucose that then enters the bloodstream. In addition, the amount andtype of foods ingested affect the amount of glucose produced.

Closed-loop algorithms employed for controlling delivery of an insulinformulation in response to sensed blood glucose levels may notadequately compensate for the affects such daily events may have onblood glucose levels. Thus, the diabetic person relying on suchclosed-loop algorithms may be at an increased risk of hypoglycemiaand/or hyperglycemia.

SUMMARY OF THE DISCLOSURE

Therefore, it is an advantage of embodiments of the present invention toprovide a closed-loop algorithm for controlling delivery of insulinformulation which more accurately calculates an infusion formulationdelivery rate based on a level of blood glucose which is sampled in abody at predefined intervals.

It is a further advantage of embodiments of the present invention toprovide a closed-loop algorithm for controlling delivery of insulinformulation which may be adjusted in real time to more accuratelydetermine whether a blood glucose level is rising or falling over apredetermined interval.

It is a further advantage of embodiments of the present invention toprovide safety limits for bolus delivery that may be compared withsamples of blood glucose parameters at predefined intervals and whichenable or disable bolus delivery based on the comparisons.

It is a further advantage of embodiments of the present invention toprovide safety limits on the amount of insulin formulation that may bestored in an accumulator during a predefined time interval.

It is a further advantage of embodiments of the present invention toprovide safety limits on the amount of insulin formulation that may bedelivered to a user during a predefined time interval.

These and other advantages are accomplished according to embodiments ofa closed-loop algorithm for use in conjunction with a process controllerfor delivering an infusion formulation. Components of the closed-loopalgorithm calculate a present value of infusion formulation in a body aswell as whether that value is rising or falling overall during apredefined time interval. The closed-loop algorithm includes an equationwhose variables are programmable in real time. The variables may be usedas control parameters which may be adjusted to adjust the algorithm tomore accurately calculate the present value of infusion formulation inthe body.

Preferred embodiments of the present invention provide a closed-loopalgorithm for use with a proportional-derivative controller fordelivering an insulin formulation which comprises an equation forcalculating a proportional component, a derivative component, and abasal component of an amount of insulin formulation to be deliveredbased on a sensed blood glucose level. Control parameters within theclosed-loop algorithm may be programmable in real time and may beadjusted to compensate for events which may significantly affect theblood glucose level.

Depending upon the context of use, the invention may include variouscombinations of these features which function together to provide bothadjustable control parameters and safety limits on the delivery ofinfusion formulation in response to a detected biological state. Variousembodiments of the invention include one or more of these features.

These and other objects, features, and advantages of embodiments of theinvention will be apparent to those skilled in the art from thefollowing detailed description of embodiments of the invention, whenread with the drawings and appended claims.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 shows a block diagram of an infusion formulation delivery systemutilizing a control system having an input-response relationship,according to preferred embodiments of the invention;

FIG. 2 shows a flow diagram of a general process performed by aclosed-loop algorithm for adjusting infusion formulation delivery as afunction of a change in a sensed biological state;

FIG. 3 shows the operation of a closed-loop algorithm used by aproportional-derivative controller;

FIG. 4 shows a flow diagram 400 illustrating a process for implementinga filter order, according to an embodiment of the invention;

FIG. 5A shows a blood glucose response curve after a higher filter orderfor the falling side of the curve has been implemented, according to oneembodiment of the present invention;

FIG. 5B shows a magnified view of a portion of the response curve ofFIG. 5A;

FIG. 6 shows flow diagram 600 to illustrate effects of implementing timewindows, according to an embodiment of the invention;

FIG. 7 shows a graph of a human blood glucose response for a user whohas ingested a meal, illustrating effects of implementing a time window,according to an embodiment of the invention;

FIG. 8 shows a graph of a human blood glucose response for a user whohas ingested a meal, illustrating effects of implementing time windows,according to an embodiment of the invention;

FIG. 9 shows flow diagram which illustrates effects of increasing thevalue of x in the trend term of Equation 4 when the trend term firstindicates that the blood glucose level is falling, according to anembodiment of the invention;

FIG. 10 shows a flow diagram illustrating effects of a programmabletrend gain on the present calculated value of the infusion formulation,according to an embodiment of the invention;

FIG. 11 shows a graph of a human blood glucose response for a user whohas ingested a meal, illustrating a trend up gain and a trend down gain,according to an embodiment of the invention;

FIG. 12 shows a flow diagram illustrating effects of disabled andenabled trend terms, according to an embodiment of the invention;

FIG. 13 shows a graph of a human blood glucose response for a user whohas ingested a meal, illustrating effects of disabled and enabled trendterms, according to an embodiment of the invention;

FIG. 14 shows a flow diagram illustrating effects of the basal ratecomponent, according to an embodiment of the invention;

FIG. 15 shows a graph of a human blood glucose response for a user whohas ingested a meal, illustrating effects of the basal rate component,according to an embodiment of the invention;

FIG. 16A shows a graph of a human blood glucose response for a user whohas ingested a meal, illustrating a process whereby a pump stroke volumeis accumulated, according to an embodiment of the invention;

FIG. 16B shows a magnified view of a portion of the response curve ofFIG. 16A; and

FIG. 17 shows a flow diagram illustrating a verification of the statusof each bolus control parameter before a bolus delivery is executed,according to an embodiment of the invention.

DETAILED DESCRIPTION OF EMBODIMENTS OF THE INVENTION

In the following description of preferred embodiments, reference is madeto the accompanying drawings which form a part hereof, and in which isshown by way of illustration specific embodiments in which the inventionmay be practiced. It is to be understood that other embodiments may beutilized and structural changes may be made without departing from thescope of preferred embodiments of the present invention.

Environment of Use

As discussed above, embodiments of the present invention relate to aclosed-loop algorithm for use in conjunction with a process controllerfor controlling the delivery of an infusion formulation to a body basedin part on a sensed biological state within the body.

Embodiments of the invention may be employed in various infusionenvironments including, but not limited to a biological implantenvironment. In preferred embodiments, the closed-loop algorithm isemployed for use in conjunction with a delivery device such as aninfusion pump utilized in an implant environment within a human body.However, other embodiments may be employed for use in other biologicalimplant or non-implant environments, including but not limited toexternal infusion devices, pumps or the like.

Furthermore, in example embodiments described herein, the closed-loopalgorithm is employed for use in conjunction with an infusion pumpconfigured for delivery of an insulin formulation used to regulateglucose levels in a diabetic user. However, other embodiments may beemployed in the delivery of other infusion formulations having otherpharmacological properties.

Closed-Loop Control System

A block diagram of an infusion formulation delivery system 100 utilizinga control system having an input-response relationship according topreferred embodiments of the invention is shown in FIG. 1. A sensor 102generates a sensor signal 112 representative of a system parameter input110 (such as a blood glucose level of a human body 108), and providesthe sensor signal 112 to a controller 104. The controller 104 receivesthe sensor signal 112 and generates commands 114 that are communicatedto the infusion formulation delivery device 106. The infusionformulation delivery device 106 then delivers the infusion formulationoutput 116 to the body 108 at a determined rate and amount in order tocontrol the system parameter 110.

Sensor 102 may comprise a sensor, sensor electrical components forproviding power to the sensor and generating the sensor signal 112, asensor communication system for carrying the sensor signal 112 tocontroller 104, and a sensor housing for enclosing the electricalcomponents and the communication system. Controller 104 may include oneor more programmable processors, logic circuits, or other hardware,firmware or software components configured for implementing the controlfunctions described herein, a controller communication system forreceiving the sensor signal 112 from the sensor 102, and a controllerhousing for enclosing the controller communication system and the one ormore programmable processors, logic circuits, or other hardware,firmware or software components. The infusion formulation deliverydevice 106 may include a suitable infusion pump, infusion pumpelectrical components for powering and activating the infusion pump, aninfusion pump communication system for receiving commands from thecontroller 104, and an infusion pump housing for enclosing the infusionpump, infusion pump electrical components, and infusion pumpcommunication system.

Closed-Loop Algorithm

FIG. 2 shows a flow diagram of a general process performed by aclosed-loop algorithm for adjusting infusion formulation delivery as afunction of, for example, the rate of change over time of a sensedbiological state. As shown in step 202, the closed-loop algorithm checksfor changes in the biological state at timed intervals. A sensing devicesuch as sensor 102 detects the change in glucose level and communicatesthe change to a control device such as controller 104 as an input to theclosed-loop algorithm. If no change is detected, the closed-loopalgorithm loops back to step 202, repeating this process until a changeis detected. When a change occurs at step 204, the closed-loop algorithmdetermines the amount and/or rate of infusion formulation required basedon the input and various parameters that have been programmed into thecontroller.

Where the infusion formulation delivery system 100 shown in FIG. 1includes a controller 104 used for controlling an insulin response to asensed blood glucose level, the closed-loop algorithm may be of theproportional-derivative (PD) type. The use of a PD type closed-loopalgorithm is advantageous, for example, when processing resources suchas processor power and/or memory may be limited. In alternativeembodiments, a proportional-integral-derivative (PID) type closed-loopalgorithm may be used.

PD controllers may utilize a closed-loop algorithm which computes both aproportional component and a derivative component of a response (output)to changes in a system parameter (input). For example, the proportionaland derivative components may be combined to calculate an amount ofinsulin formulation to be delivered in response to a present sensedblood glucose level (system parameter input 110) within a body 108. Thecontroller may then issue commands 114 to, for example, output acalculated amount of insulin formulation (output 116) to an infusionsite on or within the body 108 based on the present sensed blood glucoselevel.

The magnitude of each component's contribution to the calculated amountof insulin formulation to be delivered to the infusion site may beexpressed by a formula or equations, such as the following equations:U _(P)=α(G _((t)) −G _(sp))  Equation 1andU _(D) =βdG/dt,  Equation 2where

-   -   U_(P) is the proportional component of the response,    -   U_(D) is the derivative component of the response,    -   α is a proportional gain coefficient,    -   β is a derivative gain coefficient,    -   G is a present blood glucose level,    -   G_(sp) is a desired blood glucose level or “set point” for the        blood glucose level, and    -   t is the time at which the blood glucose level is sensed.

There is a desired blood glucose level G_(sp) for each person which maybe determined, for example, from experimentation or from the person'shistorical physiological data. The closed-loop control system may bedesigned to maintain the desired blood glucose level G_(sp) for aparticular person. It may do this, in part, by measuring the differencebetween the determined G_(sp) and a blood glucose level G sensed at timet (G_((t))). This difference is the blood glucose level error at time tthat must be corrected.

The proportional component expressed in Equation 1 determines whetherthe blood glucose level error is positive, negative, or zero, (i.e.,whether G_((t)) is, respectively, higher, lower, or equal to G_(sp)).Thus, G_(sp) is subtracted from G_((t)). If G_((t)) is higher thanG_(sp), the controller 104 may generate an insulin formulation deliverycommand 114 to drive the infusion formulation delivery device 106 toprovide insulin formulation (output 116) to the body 108. If G_((t)) islower than G_(sp), the controller 104 may reduce or stop delivery of theinsulin formulation to the body 108 by the infusion formulation deliverydevice 106. The result of subtracting G_(sp) from G_((t)) is thenmultiplied by a proportional gain coefficient α. The derivativecomponent dG/dt expressed in Equation 2 determines if the blood glucoselevel is presently rising or falling and at what rate of change.

Thus, to determine the amount of infusion formulation to be delivered atany point in time (I_((t))), the following standard equation may beused:I _((t))=α(G _((t)) −G _(sp))+βdG/dt  Equation 3where I_((t)) is the amount of insulin formulation to be delivered basedon the sensed blood glucose level at time t.Example Operation of a Closed-Loop Algorithm

Referring now to FIG. 3, the operation of a closed-loop algorithm usedby a PD controller is described. FIG. 3 illustrates a typical humanblood glucose response to the ingestion of a meal. Shown in FIG. 3 is agraph of a blood glucose response curve 300 (on the y axis) as afunction of time (on the x axis). This blood glucose response curve 300is representative of blood glucose levels sensed at various samplingtimes as a system parameter 110 by a sensor 102, as shown in FIG. 1.

As shown in FIG. 3, after a person ingests a meal 302, there istypically a steady rise 304 in blood glucose level over time until theblood glucose level reaches a peak 306. It has been observed fromexperimentation that peak 306 may occur approximately 90 minutes afteringestion of the meal. After peak 306 has been reached, it has beenobserved that the blood glucose level then begins to decrease 308 overtime. During the decline from the first peak 306, a second temporaryrise 310 in blood glucose level has been observed. A second peak 312results from this temporary rise 310. This second peak 312 may occurapproximately 30 to 90 minutes after the occurrence of peak 306 andtypically tends to occur 30 to 60 minutes after the occurrence of peak306.

After peak 312 has been reached, it has been observed that the bloodglucose level then continues as before to decrease 314 over time.Although the reasons for this second, temporary rise 310 are notcompletely understood at the present time, it is a consistentlyobservable phenomenon that presents a problem for a closed-loopalgorithm.

To understand the problem, it is helpful to understand the response of aclosed-loop algorithm at the various points of the response curve 300shown in FIG. 3. As stated above, at point 302, the meal is ingested. Asthe blood glucose level rises 304 above the set point 316, a closed-loopalgorithm may calculate both the amount by which the present bloodglucose level exceeds the set point value (a proportional component) andmay also determine that the blood glucose level is rising at a certainrate (a derivative component). Thus, a closed-loop algorithm maycalculate a result based on these two components which causes a commandto issue from a controller associated with the algorithm to deliver acalculated amount of insulin at a time t on the response curve 300corresponding to 304.

At peak 306 of the response curve 300, the blood glucose level isneither rising nor falling, but the proportional component calculatesthat it is still above the set point and therefore the controllerassociated with the closed-loop algorithm may continue to issue commandsto deliver more insulin formulation, although it may not be as large anamount as that issued at 304 on the response curve 300.

At 308, the proportional component calculates that the blood glucoselevel is still above the set point. However, now the blood glucose levelis falling, and therefore the controller associated with the closed-loopalgorithm may issue commands to deliver a decreased amount of insulinformulation based on the calculation of the derivative component.

At 310, the proportional component calculates that the blood glucoselevel is still above the set point. The derivative component willcalculate that the blood glucose level is rising again. At this point,the controller associated with the closed-loop algorithm may issue acommand to deliver another significant amount of insulin based on thisinformation although, seen globally, the blood glucose level isdecreasing overall. Thus, because of this additional input of insulinformulation into the system, the risks of hypoglycemia to the user areincreased.

Embodiments of Closed-Loop Algorithms

Preferred embodiments of the present invention address the limitationsof a closed-loop algorithm exemplified above in relation to FIG. 3.Preferred embodiments of closed-loop algorithms more accuratelydetermine the amount of insulin formulation to be delivered based on asensed blood glucose level by including programmable control parameterswhich may be used to introduce discontinuities in the calculation ofI_((t)) unlike the continuous calculations of I_((t)) performed by theclosed-loop algorithm described above. Embodiments of the presentinvention may be more effective at maintaining a desired blood glucoselevel for a particular user under circumstances where blood glucoselevel may be significantly affected by events such as, but not limitedto meals, sleep, and exercise. As a result, the risk of hypoglycemiaand/or hyperglycemia in the user may be reduced.

In some embodiments of the present invention, the derivative componentof the closed-loop algorithm (dG/dt) shown in Equation 2 above isreferred to as the “trend term” and may be expressed as:Trend term=(G _((t)) −G _((t−x)))/x  Equation 4

-   -   where x is a numerical value representing an increment of time.

In some embodiments, the value of the trend term is calculated atpredetermined intervals, for example each minute, and is used todetermine the “trend” of G, i.e., whether the value of G is trending upor trending down during a timeframe determined by the term (t−x). Thus,by changing the value of x, the timeframe for sampling the trend may belengthened or shortened. As an example, using Equation 4, if x=10minutes, the blood glucose level sensed 10 minutes prior in time to timet is subtracted from the blood glucose level sensed at time t. In someembodiments, as discussed in more detail below, the value of x may beprogrammable. In alternative embodiments, linear regression or othercurve-fitting techniques may be used.

Generally, a shorter timeframe (and, thus, a smaller value of x) ispreferred for trend calculation because the shorter the timeframe, themore responsive the infusion formulation delivery system may be to arising or falling blood glucose level. However, this responsiveness mustbe balanced against noise susceptibility of the sensor signal, which mayincrease as the timeframe gets shorter. After the trend term iscalculated, it is multiplied by the derivative gain coefficient β.

The proportional gain coefficient α and derivative gain coefficient β (βis also referred to in the present disclosure as the “trend gain”) maybe chosen based, for example, on experimentation. As an example, theymay be chosen based on observations of the insulin response of severalnormal glucose tolerant users. An average of the values of theseresponses may then be taken. Alternatively, other statistical valuesbesides an average value may be used, for example a maximum or minimumvalue, standard deviation value, or some other suitable value.

In some embodiments, as discussed in more detail below, both theproportional and derivative gain coefficients may be programmable. Inaddition, β may be programmed as one value when the trend is going upand a different value when the trend is going down (also referred to inthe present disclosure as the “trend up” and “trend down” gains).

It is believed that even if G_((t)) is equal to G_(sp) (in other wordsif the proportional component of the response is zero), a certainminimal amount of insulin formulation should still be delivered in orderto maintain that condition. Thus, in some embodiments, in addition toEquation 1 and Equation 2 shown above, a basal insulin formulationdelivery amount is included as a further component of the response. Thisbasal component (B₀) represents, in some embodiments, a minimum amountof insulin formulation that would be delivered when G_((t)) is equal toor greater than G_(sp) (i.e., when the blood glucose level at time t isequal to or greater than the desired blood glucose level or set point)and without regard to the rate at which the blood glucose level isrising or falling. In some embodiments, as discussed in more detailbelow, B₀ may be programmable and may be selected from a programmabletable of multiple B₀ values based on certain criteria. By selecting B₀values from this programmable table, different values of B₀ may beselected for different parts of the day (for example, dawn). Thus,different parts of the day may be treated differently than other partsof the day.

Thus, to determine the amount of infusion formulation to be delivered atany point in time (I_((t))) the following equation may be used byembodiments of the present invention:I _((t))=α(G _((t)) −G _(sp))+β((G _((t)) −G _((t−x)))/x)+B ₀  Equation5Higher Order Filters for Down Trend

Generally, the body's blood glucose level changes slowly compared to therate at which the sensor 102 samples these levels. Therefore, highfrequency signal components are typically noise. Referring again to FIG.1, in some embodiments of the present invention sensor 102 may furtherinclude a filter. The filter may be used to reduce noise seen in sensorsignal 112 in particular frequency bands prior to being received bycontroller 104. In some embodiments, a low pass filter such as, but notlimited to, a finite impulse response (“FIR”) filter, is used for thispurpose. This filter may be adjusted to pass lower frequencies and stophigher frequencies.

By increasing the order of the FIR filter, a sharper cutoff in thefrequency response of the low pass filter may be achieved. In oneembodiment of the present invention, the order of the filter may beprogrammable and different orders of the filter may be implemented basedon whether the blood glucose level response curve (for example, responsecurve 300 in FIG. 3) is rising or falling.

FIG. 4 shows a flow diagram 400 illustrating the process forimplementing a filter order. As illustrated in flow diagram 400, in oneembodiment the derivative component of Equation 5 may be sampled at step402. If the derivative component of Equation 5 is a positive value orzero, i.e., if the blood glucose level is rising or at a peak, thefilter order may be maintained as shown in step 404. If the derivativecomponent of Equation 5 is a negative value, i.e., if the blood glucoselevel is falling, a higher order filter may be implemented at step 406.As a result of implementing a higher order filter when the blood glucoselevel is falling, the temporary peaks on the falling side of theresponse curve (such as peak 312 in FIG. 3) may be flattened, asillustrated in FIGS. 5A and 5B.

FIGS. 5A and 5B illustrate the effects of this embodiment of the presentinvention on a response curve such as response curve 300. FIG. 5A showsa response curve 500 after the higher filter order for the falling sidehas been implemented according to one embodiment of the presentinvention described above. FIG. 5B shows a magnified view of a portionof the response curve referred to in FIG. 5A by numeral 518.

It can be seen from FIG. 5B that the second peak 512 (corresponding tosecond peak 312 in FIG. 3) has been flattened as a result of the higherorder filter. Thus, the derivative component of the closed-loopalgorithm may not detect as steep a rise and may reduce the amount ofinsulin formulation delivered as a result of this second peak 512.Therefore, as a result of implementing embodiments of the invention, therisk of hypoglycemia to the user may be reduced.

Disabling Closed-Loop Algorithm During Predefined Time Window

In another embodiment of the present invention, after a meal has beeningested by a user, the amount of insulin formulation to be deliveredbased on a sensed blood glucose level may be more accurately determinedby establishing, for example from historical physiological data, a timewindow within which the temporary rise in blood glucose level occurs inthe user. Once this time window has been established, embodiments of thepresent invention may disable any further commands from issuing from thecontroller (for example, commands 114 from controller 104 in FIG. 1),by, for example, programming start and stop times for the time windowthat may be used by the controller to suspend any further calculationsof I_((t)) during the time window.

FIG. 6 shows flow diagram 600 which illustrates the effects ofimplementing time windows, as described above. As illustrated in flowdiagram 600, in one embodiment the current time t may be sampled andcompared at step 602 to the programmed start and stop times to determineif time t is within the programmed time window. If time t is not withinthe programmed time window, the issuance of commands based on Equation 5may be enabled at step 604. If time t is within the programmed timewindow, the issuance of commands based on Equation 5 may be disabled atstep 606 until the programmed stop time. In this way, minimal or noadditional insulin formulation may be delivered during the time window,as illustrated by the graph shown in FIG. 7.

FIG. 7 shows a graph of a human blood glucose response 700 for a userwho has ingested a meal at the point in time referred to by numeral 702.For the purposes of illustration, it will be assumed that it has beenestablished from the user's historical physiological data that thesecond rise occurs in the user at the time referred to by numeral 724.Thus, in the present example, the second peak 712 occurs approximatelytwo hours after the meal is ingested. Thus, the time window fordisabling commands from being issued by the controller may be setbetween a disable start time, referred to by numeral 726, and a disablestop time, referred to by numeral 728. After time 728 is reached, thecontroller commands may again be enabled.

It can be seen from FIG. 7 that because the second rise 710 andresulting second peak 712 occur within the programmed time window, thesecond rise does not result in any increase in delivered insulinformulation. This discontinuity in the calculation of I_((t)) may thuscause I_((t)) to be calculated based only on the global downward trendof response curve 700. Therefore, as a result of implementing oneembodiment of the invention, the temporary rise 710 does not cause anyincrease in the amount of delivered insulin formulation, and the risk ofhypoglycemia to the user is reduced.

Programmable Control Parameters for Equation 5

In yet another embodiment of the present invention, the amount ofinsulin formulation to be delivered based on a sensed blood glucoselevel may be more accurately determined by having control parameters inEquation 5 which are programmable. In some embodiments, higher accuracyis achieved by including some control parameters which may beprogrammable in real time, i.e., while the closed-loop control system isin operation. Table 1 shows the control parameters within Equation 5that may be programmable in different embodiments of the presentinvention. In some embodiments, all the control parameters shown inTable 1 are programmable. In one embodiment, the control parametersshown in Table 1 may be programmed in real time. Table 1 also includesexample values for each control parameter.

TABLE 1 Control Parameter Value Glucose Set Point (G_(sp)) 100 mg/dlBasal Rate (B₀) 0.5 units/hour Proportional Gain (α) 0.01 units/hourTrend Term 2 mg/dl/minute Trend Up Gain (β) 1.0 units/hour *(mg/dl/minute) Trend Down Gain (β) 3.0 units/hour * (mg/dl/minute)

Some embodiments of the present invention use the programmable controlparameters shown in Table 1 to advantageously adjust the closed-loopalgorithm to compensate for changes in the blood glucose level thatresult from events such as, but not limited to, a meal event. Thetemporary rise in blood glucose level seen a period of time after themeal has been ingested is an example of a change in blood glucose levelresulting from an event. Other events that may require compensation forchanges in the blood glucose level include, but are not limited toexercise, illness, stress, sleep and other events which may inducemetabolic changes. Some embodiments may adjust the control parameters tocompensate for the temporary rise so that it does not result in thedelivery of a significant amount of insulin formulation. Thus, theseembodiments decrease the risks of hypoglycemia to the user.

In one embodiment, the timeframe of the trend term of Equation 4 may belengthened by increasing the programmable value of x. This embodiment isillustrated by the graph shown in FIG. 8, which shows a human bloodglucose response 800 for a user who has ingested a meal at the point intime referred to by numeral 802. A first timeframe wherein x=10 minutesis referred to by numeral 804 and defines a 10 minute timeframeextending back in time from time t. It can be seen that if a trend termis calculated at time t, the trend of the blood glucose level will becalculated as rising 808 for that defined timeframe.

By increasing the value of x in the trend term, the timeframe may belengthened in order to decrease the responsiveness of the infusionformulation delivery system and calculate a trend term that is moreaccurate in terms of whether the blood glucose level is globally risingor falling.

This is illustrated by a second timeframe, referred to by numeral 806,wherein x=30 minutes and defines a 30 minute timeframe extending back intime from time t. It can be seen that for the majority of the periodencompassed by timeframe 806 the blood glucose level is trendingdownward. Thus, the overall calculation of the trend term will result ina negative value. Thus, by increasing the programmable value of x inorder to define a longer timeframe in which to sample the trend, a moreaccurate calculation is made of I_((t)), thus reducing the risk ofhypoglycemia to the user.

In a further embodiment, the value of x in the trend term of Equation 4may be increased only for the falling side of blood glucose responsecurve 800. Thus, in this embodiment, the controller may be programmed toincrease the value of x in the trend term of Equation 4 when the trendterm first indicates that the blood glucose level is falling. In thismanner, the better responsiveness of the shorter timeframe may bemaintained while the blood glucose level is rising.

FIG. 9 shows flow diagram 900, which illustrates effects of increasingthe value of x in the trend term of Equation 4 when the trend term firstindicates that the blood glucose level is falling. The trend may besampled at step 902 at time t and it may be determined whether or notthe trend is falling. If the trend is not falling, the timeframe may bemaintained, as shown at step 904. If the trend is falling, the timeframemay be increased, as shown at step 906. In this way, the trend controlparameter of the closed-loop algorithm may be adjusted in such a waythat the temporary rise in the blood glucose level may have no effect onthe overall, global trend of the blood glucose level over time.

Thus, the embodiment illustrated in FIG. 8 uses the programmable trendterm parameter shown in Table 1 to advantageously adjust the closed-loopalgorithm such that the temporary rise in blood glucose level does notresult in the delivery of a significant amount of insulin formulationand thus reduces the risks of hypoglycemia to the user.

In other embodiments of the present invention, the trend up and trenddown gain control parameters may be used to advantageously adjust theclosed-loop algorithm such that the temporary rise in blood glucoselevel does not result in the delivery of a significant amount of insulinformulation. As stated above, the trend gain control parameter β may bechosen based on observations of the insulin response of several normalglucose tolerant users.

It has been determined through experimentation that the risk ofhypoglycemia may be reduced by rapidly cutting off insulin formulationdelivery to the user once it is determined that the trend is falling. Insome embodiments, therefore, the trend gain may be programmable and mayhave a greater value when the trend is falling (trend down gain) and alesser value when the trend is rising (trend up gain).

FIG. 10 shows a flow diagram 1000 illustrating the effects of aprogrammable trend gain. The trend may be sampled at step 1002 at time tand it may be determined whether or not the trend is falling. If thetrend is not falling, the trend up gain may be used in Equation 5, asshown at step 1004. If the trend is falling, the trend down gain may beused in Equation 5, as shown at step 1006. In this way, the trend gaincontrol parameter of the closed-loop algorithm may be adjusted in such away that the temporary rise in the blood glucose level may have noeffect on the overall, global trend of the blood glucose level overtime.

FIG. 11 illustrates why this may be advantageous in preventing thedelivery of a significant amount of insulin formulation in response tothe temporary, second rise in blood glucose level seen after a meal.FIG. 11 shows a graph of a human blood glucose response 1100 for a userwho has ingested a meal at the point in time referred to by numeral1102. Also shown in FIG. 11 is a timeframe, referred to by numeral 1106,wherein x=10 minutes and defines a 10 minute timeframe extending back intime from time t.

At time t₁, the trend of the blood glucose level is sampled and isdetermined to be rising 1104. Thus, the trend term will be some positivevalue. As an example, the trend term may have a value of 2 mg/dl/minute,as shown in Table 1 above. As seen in Equation 5, this value will bemultiplied by the trend gain, and because it is positive, the trend upgain will be used. In this example, the trend up gain is chosen as 1.0units/hour*(mg/dl/minute), as shown in Table 1. Thus, the derivativecomponent of Equation 5 may be calculated as 1.0units/hour*(mg/dl/minute)*2 mg/dl/minute=2 units/hour. It can be seen,therefore, that because, in the present example, the trend is rising ata rate of 2 mg/dl/minute, an additional 2 units/hour of insulinformulation is added to the proportional component and the basalcomponent of Equation 5.

In contrast, when the trend is falling, a larger value of trend gain,i.e., the trend down gain, is used. Shown in FIG. 11 is a timeframe,referred to by numeral 1110, wherein x=10 minutes and defines a 10minute timeframe extending back in time from time t. At time t₂ thetrend of the blood glucose level is sampled and is determined to befalling 1108. Thus, the trend term will be some negative value. As anexample, the trend term may have a value of −2 mg/dl/minute, as shown inTable 1 above. As seen in Equation 5, this value will be multiplied bythe trend gain, and because it is negative, the trend down gain is used.In this example, the trend down gain is chosen as 3.0units/hour*(mg/dl/minute), as shown in Table 1. Thus, the derivativecomponent of Equation 5 may be calculated as 3.0units/hour*(mg/dl/minute)*−2 mg/dl/minute=−6 units/hour. It can be seen,therefore, that because in the present example the trend is falling at arate of 2 mg/dl/minute, it is calculated that 6 units an hour should besubtracted from the current insulin formulation delivery rate.

In some embodiments, the trend down gain may be chosen such that thecalculation of the derivative component of Equation 5 results in a highenough negative value to completely offset the other components ofEquation 5 and, thus, to substantially cut off further delivery ofinsulin formulation during the down trend, even though the blood glucoselevel is currently above the set point 1116. Thus, embodiments may use ahigh enough value for the trend down gain such that the temporary risein blood glucose level may have no effect, since the delivery of insulinformulation may be cut off at a time t before the temporary rise occurs.Thus, the risk of hypoglycemia to the user is reduced.

In other embodiments of the present invention, the closed-loop algorithmadvantageously disables the trend term from contributing to I_((t))under certain circumstances in order to further reduce the risks ofhypoglycemia to a user. In one embodiment, the trend term of Equation 5is disabled and does not contribute to I_((t)) unless the trend isrising and the user's goal blood glucose level has been reached.

This is illustrated in flow diagram 1200 shown in FIG. 12. The bloodglucose level may be sampled at step 1202 and it may be determinedwhether or not the user's goal (set point) has been reached. If the goalhas not been reached, the trend term may be disabled, as shown at step1204. If the goal has been reached, the trend term may be enabled, asshown at step 1206. In this way, the closed-loop algorithm may beadjusted in such a way that a significant amount of insulin formulationmay not be delivered to the user unless the user's blood glucose levelis both rising and, at the same time, above the user's blood glucoselevel set point, thus reducing the risk of hypoglycemia.

FIG. 13 illustrates one embodiment. FIG. 13 shows a graph of a humanblood glucose response 1300 for a user who has ingested a meal at thepoint in time referred to by numeral 1302. The blood glucose levelbegins to rise 1304, but is still below the user's set point value 1316.Thus, in one embodiment the derivative component of Equation 5 isdisabled and does not contribute to I_((t)). When the blood glucoselevel reaches the set point 1316 at time t, the derivative component ofEquation 5 is enabled and begins to contribute to I_((t)).

Shown in FIG. 13 is a timeframe, referred to by numeral 1306, whereinx=10 minutes and defines a 10 minute timeframe extending back in timefrom time t. At time t the trend of the blood glucose level may besampled to determine the difference between the blood glucose level attime t and at time t−10, as described above in relation to FIG. 11.Therefore, once the user's blood glucose level is both rising and abovethe set point, the trend term of Equation 4 (which is equivalent to thederivative component of Equation 5) may be calculated. An additionalamount of insulin formulation determined by the calculation may then bedelivered to the user to assist in metabolizing the blood glucose.

In other embodiments of the present invention, the closed-loop algorithmadvantageously enables and disables the basal bate B₀ component ofEquation 5, which may be a programmable control parameter (as shown inTable 1 above). In one embodiment, the basal rate component may beenabled or disabled based in part on whether the user's blood glucoselevel is above or below, respectively, the user's set point.

As discussed above, the basal rate component B₀ of Equation 5represents, in some embodiments, a minimum amount of insulin formulationthat would be delivered when the blood glucose level at time t is equalto or greater than the desired blood glucose level or set point andwithout regard to the rate at which the blood glucose level is rising orfalling. Embodiments advantageously disable the basal rate component B₀of Equation 5 from contributing to I_((t)) when the blood glucose levelfalls below the set point and the trend term is falling. This may bedone, for example, to substantially inhibit any further delivery ofinsulin formulation when the blood glucose level has fallen from amaximum value to a point below the set point.

FIG. 14 shows a flow diagram 1400, illustrating the effects of the basalrate component of Equation 5. The blood glucose level may be sampled atstep 1402 and it may be determined whether or not the user's bloodglucose level is below the set point. If the blood glucose level is notbelow the set point, the basal rate component of Equation 5 may beenabled, as shown at step 1404. If the blood glucose level is below theset point, the trend may be sampled and it may be determined whether ornot the trend is falling, as shown at step 1406. If the trend is notfalling, the basal rate component of Equation 5 may be enabled, as shownat step 1404. If the trend is falling, the basal rate component ofEquation 5 may be disabled, as shown at step 1408. In this way, thebasal rate component of Equation 5 would be enabled when the bloodglucose level sampled at time t is equal to or greater than the setpoint value regardless of the trend direction and would be disabled whenthe blood glucose level sampled at time t is less than the set pointvalue and the trend is falling.

FIG. 15 illustrates one embodiment. FIG. 15 shows a graph of a humanblood glucose response 1500 for a user who has ingested a meal at thepoint in time referred to by numeral 1502. The blood glucose levelbegins to rise 1504, but is below the user's set point 1516. Thus,according to the one embodiment, even though the user's blood glucoselevel is below the set point 1516, the basal rate component of Equation5 is enabled because the trend is not falling. The blood glucose levelis still rising at 1506 and is now above the user's set point 1516.Thus, because the user's blood glucose level is both above the set point1516 and rising, the basal rate component of Equation 5 is enabled.According to one embodiment, under the conditions described above inrelation to 1504 and 1506, the basal rate component of Equation 5 isenabled and contributes to I_((t)).

At 1508, the blood glucose level is falling, but is above the user's setpoint 1516. Thus, even though the user's blood glucose level is falling,it is still above the set point 1516 and, therefore, the basal ratecomponent of Equation 5 is enabled. At 1510, the blood glucose level isstill falling and is now below the set point. Thus, because the bloodglucose level is both falling and below the set point, the basal ratecomponent of Equation 5 is disabled and does not contribute to I_((t)).Therefore, one embodiment substantially cuts off any insulinformulation, including the basal rate component, when the glucose levelis both falling and below the set point. In this way, embodiments reducethe risk of hypoglycemia.

Further embodiments of the present invention may include a programmabletable of basal rate values. The closed-loop algorithm may beprogrammable to select particular basal rate values from the table to beused in calculating I_((t)) in Equation 5, for example, at particulartimes of the day. As an example, a different basal rate value may beselected at particular time intervals throughout the day. In oneembodiment, the basal rate value may be updated every 30 minutes. Infurther embodiments, other control parameters within the closed-loopalgorithm may be adjusted differently at different times of the day.

Thus, embodiments may advantageously adjust the basal rate based ondaily events such as, but not limited to, meals, sleep, exercise, stressinducing events, ingested medications, and the like. In addition,embodiments enable the updating of basal rate values based on aparticular user's historical physiological data. For example, aparticular user may have a lower need for insulin at night. For thatuser the closed-loop algorithm may be programmed to use lower basal ratevalues at night.

Monitoring Biological States Other Than Blood Glucose Level

In further embodiments of the present invention, the amount and/or rateof delivered insulin formulation may modified based on inputs fromsensing devices that detect other biological states in lieu of or inaddition to the sensed blood glucose level. For example, it has beenobserved that a user's blood oxygen levels may change based on whetherthe user is awake or sleeping. As discussed above, sleep is an eventwhich may significantly affect blood glucose levels in particular users.Thus, embodiments may sense the blood oxygen level of a user todetermine if the user is asleep and input this information to theclosed-loop algorithm in order to adjust the amount and/or delivery rateof insulin formulation based on this information.

Similarly, it has been observed that body temperature may significantlyaffect blood glucose levels. Thus, one embodiment includes a temperaturesensor which monitors body temperature and includes this information asan input to the controller in order to adjust the amount and/or deliveryrate of insulin formulation based on this information.

Further embodiments of the present invention may include a sensingdevice for detecting whether or not a user is exercising. In oneembodiment, an accelerometer or other device suitable for detectingmotion may be used to detect motion as an indicator of current physicalactivity. As discussed above, exercise may significantly affect bloodglucose levels in particular users. Thus, information from the exercisesensing device may be input to the controller in order to adjust theamount and/or delivery rate of insulin formulation based on thisinformation.

Referring again to FIG. 1, in one embodiment sensor 102 may sense manybiological states including, but not limited to, blood glucose level,blood oxygen level, and temperature. Sensor 102 may further include anexercise sensing device such as an accelerometer. In other embodiments,a separate blood glucose level sensor, blood oxygen level, temperaturesensor and exercise sensing device may be used. Further embodiments mayinclude sensors that detect various combinations of these and/or otherbiological states.

Reduction of Accumulated Insulin Formulation

An infusion pump for the delivery of an infusion formulation accordingto some embodiments has a fixed pump stroke volume, i.e., there is acertain minimum value of infusion formulation that must be accumulatedbefore a pump stroke is executed, referred to in the present disclosureas a “pump stroke volume.” Thus, if I_((t)) is calculated on a periodicbasis, for example each minute, then the calculated amount for eachminute may be some fractional part of a pump stroke volume. Thesefractional parts may be stored, for example, in a chamber or reservoirwithin or adjacent to the infusion pump until an amount equal to thepump stroke volume has been accumulated. At that time, a pump stroke maybe executed and the insulin formulation delivered.

The process where a pump stroke volume is accumulated is illustratedwith reference to FIGS. 16A and 16B. FIG. 16A shows a graph of a humanblood glucose response 1600 for a user who has ingested a meal at thepoint in time referred to by numeral 1602. FIG. 16B shows a magnifiedview of a portion of the response curve referred to in FIG. 15A bynumeral 1608.

The blood glucose level begins to rise 1604. At time t₁, a first valuefor I_((t)) may be calculated using Equation 5. The amount of insulinformulation calculated as I_((t)) at time t₁ may be some fractional partof a pump stroke volume and may be stored in the accumulator. At timet₂, a second value for I_((t)) may be calculated. The amount of insulinformulation calculated as I_((t)) at time t₂ may also be some fractionalpart of a pump stroke volume and may be added to the first value storedin the accumulator. At time t₃, a third value for I_((t)) may becalculated, and so on.

At time t_(n), an nth value of I_((t)) is calculated using Equation 5.The amount of insulin formulation calculated as I_((t)) at time t_(n) isadded to the accumulator, at which time the amount of insulinformulation in the accumulator is equivalent to a pump stroke volume. Apump stroke may now be executed to deliver the insulin formulation. Timet_((n)) may vary based on the pump stroke volume and the intervals atwhich I_((t)) is calculated.

As stated above, a process controller employing a closed-loop algorithmto control the delivery of an insulin formulation may be restricted toadding insulin formulation to the system, i.e., a body. Once insulinformulation is added to the system, normally the controller cannotretrieve it.

In further embodiments of the present invention, the accumulated volumeof infusion formulation may be purged from the accumulation chamber orreservoir (also referred to in the present disclosure as the“accumulator”) when the calculation of I_((t)) yields a result whichshows that the blood glucose level is falling. Thus, although oncedelivered the infusion formulation may not be retrievable from the body,it may be retrieved from the accumulator before the pump stroke isexecuted.

In one embodiment, at any time before a pump stroke is executed, thecontroller may issue a command to purge the accumulator. For example,once it is determined that the blood glucose level is falling anddelivery of further insulin formulation is not desirable, the amounts ofinsulin formulation that were calculated at times t₁ through t_(n) whilethe blood glucose level was rising may be purged from the accumulatoronce the blood glucose level begins to fall. Thus, the accumulator maybe advantageously “zeroed out.” In addition, under circumstancesinvolving high levels of blood glucose, the accumulator may be allowedto go negative, thus delaying the effect of future increases in bloodglucose levels.

Programmable Control Parameters for Bolus Safety Limits

In further embodiments of the present invention, a large amount ofinsulin formulation (a “bolus”) may be delivered by the infusionformulation delivery device, independently of Equation 5, when a userhas a blood glucose level that is above a predefined value and is risingat or above a predefined rate, thus possibly indicating that a meal hasbeen consumed. In other words, when the predefined criteria is met, thebolus amount may be delivered instead of a value of I(t) calculatedusing Equation 5.

In preferred embodiments, predefined bolus safety limits are included ascontrol parameters for the closed-loop algorithm. In some embodiments,the bolus control parameters may be programmable in real time. Table 2shows example bolus safety limit control parameters that may beprogrammable in different embodiments of the present invention. In someembodiments, all the control parameters shown in Table 2 areprogrammable. In one embodiment, the control parameters shown in Table 2may be programmed in real time. Table 2 also includes example values foreach control parameter.

TABLE 2 Control Parameter Value Bolus amount Up to 25 units inincrements of 0.2 units; preferably 1-8 units Time between boluses Oneminute to 24 hours; preferably 30-60 minutes Bolus threshold 50-200mg/dl; preferably 80-160 mg/dl Bolus trend Varies from individual toindividual; typically 1-5 mg/dl/min for humans; preferably 2-4 mg/dl/min

Preferred embodiments of the present invention use the programmablecontrol parameters shown in Table 2 to advantageously provide safetylimits to be used in order to reduce the possibility of erroneouslydelivering a bolus by ensuring that the status of each control parameteris verified before a bolus delivery is executed by the infusionformulation delivery device. This is illustrated by flow diagram 17,shown in FIG. 17.

As discussed above, the blood glucose level is sampled at intervals, forexample every minute. In some embodiments, each time the blood glucoselevel is sampled, a check is performed by the closed-loop algorithm todetermine the status of the control parameters shown in Table 2.

In one embodiment, the closed-loop algorithm first determines if a bolusdelivery feature is enabled 1702. This may be determined, for example,by comparing a predefined “bolus amount” control parameter value withzero. If the value is equal to zero, bolus delivery may be disabled1704. If the value is greater than zero, the “time between boluses”control parameter may be checked 1706.

The “time between boluses” control parameter determines whether or not apredefined time interval has been exceeded since the last bolusdelivery. If the time interval between bolus deliveries has not beenexceeded, bolus delivery may be disabled 1704. If the time intervalbetween bolus deliveries has been exceeded, the “glucose threshold”control parameter may be checked 1708.

The “glucose threshold” control parameter determines whether or not apredefined blood glucose level has been reached. If the predefined bloodglucose level has not been reached, the bolus delivery feature may bedisabled 1704. If the predefined blood glucose level has been reached,then the “bolus trend” control parameter may be checked 1710.

The “bolus trend” control parameter determines whether or not the bloodglucose level is rising at a predefined rate. If the blood glucose levelis not rising at the predefined rate, then the bolus delivery featuremay be disabled 1704. If the blood glucose level is rising at thepredefined rate, then the bolus delivery feature may be enabled 1712.Also, according to an embodiment of the present invention, additionalsignal processing may be implemented to detect a signature of a meal,which may then be used to enable the bolus feature.

Thus, embodiments advantageously provide bolus safety limits to reducethe possibility of erroneously delivering a bolus by ensuring thatpredefined conditions for delivery of a bolus are met by testingpredefined control parameters that are programmable. Thus, theclosed-loop algorithm reduces the possibility of delivering too muchinsulin formulation as a bolus and thus reduces the risks ofhypoglycemia to the user.

Programmable Control Parameters for Maximum Insulin Formulation DeliveryAmounts

In yet other embodiments of the present invention, additional safetylimits may be used to ensure that no more than a predefined maximumamount of insulin formulation is stored in the accumulator at eachsampling interval. For example, when the sampling interval is oneminute, a limit may be set on the maximum amount of insulin formulationthat may be stored in the accumulator each minute. This amount may beprogrammable.

Similarly, in yet a further embodiment, a limit may be set on themaximum amount of insulin formulation that may be delivered by theinfusion formulation delivery device in one hour. This amount may alsobe programmable.

Thus, by “clamping” the maximum amount that may be stored in theaccumulator at each sampling period and the maximum amount that may bedelivered to the body each hour, embodiments of the present inventionreduce the possibility of delivering too much insulin formulation andthus reduce the risks of hypoglycemia to the user.

Accordingly, a number of aspects and features of preferred embodimentsof the closed-loop algorithm described above may provide programmablecontrol parameters for tuning the closed-loop algorithm to moreaccurately determine an amount of insulin formulation to be delivered inresponse to a sensed blood glucose level in order to reduce the risks ofhypoglycemia to a user. Additional aspects and features of preferredembodiments of the closed-loop algorithm may provide safety limits whichreduce the risks of hypoglycemia to a user. The aspects and featuresdescribed above may be combined to provide maximum control and safetyfor a user. However, the foregoing description of embodiments of theinvention has been presented for the purposes of illustration anddescription. It is not intended to be exhaustive or to limit theinvention to the precise forms disclosed. Many modifications andvariations are possible in light of the above teaching.

For example, several embodiments of the closed-loop algorithm weredescribed above in relation to a graph of a human blood glucose responsefor a user who has ingested a meal. These examples are meant to beillustrative and not limiting. The meal event is used as an example ofan event which may lead to changes in insulin production by the pancreasof a non-diabetic person, and for which the tuning of the closed-loopalgorithm using control parameters may be advantageous. However, themeal event should not be considered to be a limitation on the eventswhich may affect glucose levels in the human body, and thus on theevents for which adjustable control parameters for tuning theclosed-loop algorithm may be advantageous.

Thus, the programmable control parameters may be adjusted to adjust theclosed-loop algorithm to more accurately calculate the amount of insulinformulation to be delivered during or after other events which mayaffect the blood glucose response of a user. For example, Theprogrammable control parameters may be adjusted to more accuratelycalculate the amount of insulin formulation to be delivered during orafter exercise events, medication events, stress events, sleep events,and the like.

Having disclosed exemplary embodiments and the best mode, modificationsand variations may be made to the disclosed embodiments while remainingwithin the scope of the invention as defined by the following claims.

What is claimed is:
 1. A method for delivering insulin formulation, themethod comprising: delivering an amount of insulin formulation inaccordance with a predefined delivery profile having a plurality ofcomponents, including a basal component that comprises a predefinedamount of insulin formulation that is delivered to maintain a targetblood glucose level; sampling a blood glucose level at predefined timedintervals; comparing the sampled blood glucose level to a predefinedblood glucose level threshold; and disabling delivery of the basalcomponent of the delivery profile, if the sampled blood glucose level isless than the predefined blood glucose level threshold.
 2. The methodrecited in claim 1, further comprising: determining if a predefined timeinterval has been exceeded since a previous bolus delivery; anddisabling the bolus delivery if the predefined time interval has notbeen exceeded.
 3. The method of claim 1, wherein comparing the sampledblood glucose level to the predefined blood glucose level threshold isperformed independent of values other than the sampled blood glucoselevel and the predefined blood glucose level threshold.
 4. The methodrecited in claim 1, wherein the basal rate component comprises an amountof insulin to deliver when the blood glucose level is at a desiredlevel, to maintain the blood glucose level at the desired level.
 5. Themethod recited in claim 1, wherein the plurality of components furtherincludes a difference component based on the difference between adesired blood glucose level and the sampled blood glucose level.
 6. Themethod recited in claim 1, wherein the plurality of components furtherincludes a derivative component based on the rate at which the bloodglucose level is changing.
 7. The method recited in claim 1, wherein theplurality of components further includes a derivative component based onthe rate at which the blood glucose level is changing and also based onwhether or not the blood glucose level is rising.
 8. The method recitedin claim 1, wherein delivering an insulin formulation comprises defininga delivery amount at a time (t) using the predefined delivery profile,including determining the plurality of components for the time (t) andadding the plurality of components determined for the time (t).
 9. Amethod for delivering an insulin formulation, the method comprising:delivering an amount of insulin formulation in accordance with apredefined delivery profile having a plurality of components, includinga basal component; sampling a blood glucose level at predefined timedintervals; comparing the sampled blood glucose level to a predefinedblood glucose level threshold; and disabling delivery of the basalcomponent of the delivery profile, if the sampled blood glucose levelcrosses the predefined blood glucose level threshold.
 10. The methodrecited in claim 9, wherein disabling delivery of the basal component ofthe delivery profile occurs if the sampled blood glucose level is lessthan the predefined blood glucose level threshold.
 11. The methodrecited in claim 9, wherein the insulin formulation is delivered as abolus.
 12. The method recited in claim 11, further comprising:determining if a predefined time interval has been exceeded since aprevious bolus delivery; and disabling the bolus delivery if thepredefined time interval has not been exceeded.
 13. The method recitedin claim 11, further comprising: determining a time window for disablinga calculation of a delivery rate of the insulin formulation; sampling acurrent time; determining if the current time is within the time window;and disabling the calculation of the delivery rate of the insulinformulation if the current time is within the time window.
 14. Themethod recited in claim 13, wherein determining a time window furthercomprises providing programmable start and stop times for the timewindow.
 15. The method recited in claim 14, wherein the programmablestart and stop times for the time window are determined from historicalphysiological data.
 16. The method recited in claim 13, furthercomprising enabling the calculation of the delivery rate of the insulinformulation if the current time is not within the time window.
 17. Themethod recited in claim 13, further comprising delivering a minimalinsulin formulation if the current time is within the time window. 18.The method recited in claim 13, further comprising delivering no insulinformulation if the current time is within the time window.
 19. Themethod recited in claim 9, further comprising delivering a bolus ofinsulin formulation if the sampled blood glucose level is greater thanthe predefined blood glucose level threshold.
 20. The method recited inclaim 9, further comprising: calculating an amount by which the sampledblood glucose level exceeds the predefined blood glucose levelthreshold; determining a rate at which the sampled blood glucose levelis changing; and delivering an amount of insulin formulation based onthe amount which the sampled blood glucose level exceeds the predefinedblood glucose level threshold and the rate at which the sampled bloodglucose level is changing.
 21. The method recited in claim 20, furthercomprising introducing an adjustment into the amount of insulinformulation delivered, wherein the adjustment is not related to theamount which the sampled blood glucose level exceeds the predefinedblood glucose level threshold or the rate at which the sampled bloodglucose level is changing.
 22. The method recited in claim 21, whereinthe adjustment is introduced via programmable control parameters. 23.The method recited in claim 20, wherein determining a rate at which thesampled blood glucose level is changing occurs at predeterminedintervals.
 24. The method recited in claim 23, wherein the predeterminedintervals are programmable.
 25. The method recited in claim 20, whereindelivering an an amount of insulin formulation comprises delivering abasal rate of insulin formulation.
 26. The method recited in claim 20,further comprising calculating an amount by which the sampled bloodglucose level is offset over time from the predefined blood glucoselevel threshold.
 27. The method recited in claim 8, further comprisingfiltering out high frequency components of the sampled blood glucoselevel.
 28. The method recited in claim 27, wherein filtering comprisesfiltering with a low pass filter.
 29. A system for delivering an insulinformulation comprising: an infusion device for delivering an amount ofinsulin formulation in accordance with control commands based on apredefined delivery profile having a plurality of components, includinga basal rate component; a data acquisition unit for sampling a bloodglucose level at predefined timed intervals; a comparator for comparingthe sampled blood glucose level acquired by the data acquisition unit toa predefined blood glucose level threshold; and a controller configuredto provide control commands to the infusion device including a commandfor disabling delivery of the basal component of the delivery profile,if the sampled blood glucose level crosses the predefined blood glucoselevel threshold.
 30. The system of claim 29, wherein the controller isconfigured to disable insulin formulation delivery if the sampled bloodglucose level is less than the predefined blood glucose level threshold.31. The system of claim 29, wherein the controller is configured tocause the insulin formulation to be delivered as a bolus.
 32. The systemof claim 31, wherein the data acquisition unit is further configured todetermine if a predefined time interval has been exceeded since aprevious bolus delivery; and wherein the controller disables the bolusdelivery if the predefined time interval has not been exceeded.
 33. Thesystem of claim 31, wherein the data acquisition unit is furtherconfigured to determine if the sampled blood glucose level is rising ata predefined rate; and wherein the controller disables the bolusdelivery if the sampled blood glucose level is rising at a rate lessthan the predefined rate.
 34. The system of claim 31, wherein the dataacquisition unit is configured to sample a current time; and wherein thecontroller is configured to: determine a time window for disabling acalculation of a delivery rate of the insulin formulation; determine ifthe current time is within the time window; and disable the calculationof the delivery rate of the insulin formulation if the current time iswithin the time window.
 35. The system of claim 34, wherein thecontroller is configured to provide programmable start and stop timesfor the time window.
 36. The system of claim 35, wherein the controllerdetermines the programmable start and stop times for the time windowfrom historical physiological data.
 37. The system of claim 34, whereinthe controller is configured to enable the calculation of the deliveryrate of the insulin formulation if the current time is not within thetime window.
 38. The system of claim 34, wherein the controller isconfigured to cause delivery of a minimal insulin formulation if thecurrent time is within the time window.
 39. The system of claim 34,wherein the controller is configured to cause delivery of no insulinformulation if the current time is within the time window.
 40. Thesystem of claim 29, wherein the controller causes an insulin formulationto be delivered if the sampled blood glucose level is greater than thepredefined blood glucose level threshold.
 41. The system of claim 29,wherein the controller is further configured to: calculate an amount bywhich the sampled blood glucose level exceeds the predefined bloodglucose level threshold; determine a rate at which the sampled bloodglucose level is changing; and deliver an amount insulin formulationbased on the amount which the sampled blood glucose level exceeds thepredefined blood glucose level threshold and the rate at which thesampled blood glucose level is changing.
 42. The system of claim 41,wherein the controller is configured to cause an adjustment to beintroduced into the amount of insulin formulation delivered not relatedto the amount which the sampled blood glucose level exceeds thepredefined blood glucose level threshold or the rate at which thesampled blood glucose level is changing.
 43. The system of claim 42,wherein the controller is configured with programmable controlparameters for introduction of the adjustment.
 44. The system of claim41, wherein the controller is configured to determine at predeterminedintervals the rate at which the sampled blood glucose level is changing.45. The system of claim 44, wherein the predetermined intervals areprogrammable.
 46. The system of claim 41, wherein the controller isconfigured to calculate an amount by which the sampled blood glucoselevel is offset over time from the predefined blood glucose levelthreshold.
 47. The system of claim 29, further comprising a filter forfiltering out high frequency components of the sampled blood glucoselevel.
 48. The system of claim 47, wherein the filter is a low passfilter.